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. � <br /> Sec.13.04 RIGHTS OF SLBJECTS OF Da,T� <br /> Subd. 1. Type of data. The rieh[s of individual on whom che data is scored or to be scored shall be as set fonh in this secaon. <br /> Subd._'. Information required to be��en indi�-idual. An individual asked to supply private or conndennal dara concerning himself shall <br /> be informed of: (a) the purpose and intendzd use of the requested da[a wi[hin the coilecdng"state agency, political subdivision,or sta[ewide sysrem; <br /> (b)whether he may refuse or is legally required to supply the requesced dara;(c)any known consequence arising from his supplying or refusing to supply <br /> priva[e or confidendal data;and(d)che idenocy of ocher persons or endaes au[horized by state or fedezal law to receive the data. This requirement shall <br /> not apply when an individual is asked [o suppiy invesrigadve da[a, pursuan[to section 13.82, subdivision�, to a law eniorcement o�cer. <br /> The commissioner of rever.ue mav olace ��e nodce reauired under this subdivision in the individual income rax or oro�ertv [as refund <br /> inscruc�ions inscead of on those forms. <br /> Subd. 3. .-�ecess to data by individual. L'oon requesc to a responsible authoriry,an individual shall be informed whe[her he is the subject <br /> of stored data on individuals, and whe�her it is cfassuied as public, pnvate or confidennal. lipon his funher request, an individual who is the subject <br /> of stored private or public data on individuals shall be sbown the daca wi[hou[any charge to him and, if he desires, shal] be informed oL the content <br /> and meaning of that data. .�her an individual has be�n shown rhe priva[e data and iiuormed of ics meaning, the data need not be disclosed co him for <br /> six months thereai[er unless a dispute or action pur�ane co chis secdon is pending or addidooal data on[he individual has been collected or creaced. <br /> The responsibie authoriry shall provide copies of the pm•ace or puolic daca upon request by the individual subject or'the data. 'Ihe responsible authorirv <br /> may require the requesane person to pay the actual cosu of making, cerafyine, and compiling the copies. <br /> The responsible authority shall comply immediately, if possible, with any reauest made pursuant to this subdivision, or wi�hin five days of <br /> [he date ot the request,excluding Saturdays,Sundays and legal holidays, if immediate comptiance is not possible. If he cannot comply with the request <br /> within tha[time,he shall so iniorm the individual,and may have an addidonal five days wichin which to comply wi[h the request,excluding Sa[urdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleceness of public or private <br /> data conceming himself. To exercise this neht,an individual shall notiry in wncing[he responsible authoriry describing the na[ure of the disagreement. <br /> The responsible auchori[y shall within 30 days ei[her: (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, includine recipienrs named by the individuaf: or(b) nodfy the individual tha[he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's sra�emenc of disaereemen[is included with the disclosed data. <br /> The determination o[[he responsible auchori[y may be appealed pursuan[ro the provisions ot the adaunistradve procedure act relacing to <br /> contested cases. <br /> DAT�, PRIVACY �DVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request <br /> for a permit or license from the City of Orono or any of i�s departments may require you to furnish certain private or <br /> confidential iniormation. <br /> You are rotified [har. <br /> 1. The information you furnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, bu[ refusal may require that the Ciry deny the permit or license. <br /> 3. The information may be shared with o[her local, state or federal a�encies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become <br /> public. <br /> 5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. <br /> (, Your full name is required to process this aoplication or permit. <br /> �,n�n F� �� ' I(�t 1���<� �C>c`�th — <br /> First titiddle Las[ <br /> �� ' <br /> Address <br /> c� I� /`�ii-� , �, � _ �.� �� <br /> Ciry Stare Zip Phone <br /> I understand my rights as stated above. <br /> f s�v-�,,w �2�.L��t����� <br /> Signature <br />